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Sinkler MA, Benedick A, Kavanagh M, Alfonso N, Vallier HA. Complications and Outcomes After Fixation of Lisfranc Injuries at an Urban Level 1 Trauma Center. J Orthop Trauma 2024; 38:e169-e174. [PMID: 38294227 DOI: 10.1097/bot.0000000000002780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations. METHODS DESIGN Retrospective cohort study. SETTING Level 1 trauma center. PATIENT SELECTION CRITERIA Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixation. OUTCOME MEASURES AND COMPARISONS Complications include infections, wound healing problems, nonunion, malunion, and posttraumatic arthrosis (PTA), and secondary unplanned procedures after a minimum of 2-year radiographic follow-up. RESULTS Mean age of the included 118 patients was 40 years (range, 18-73 years) and 96 (74%) were male. Comorbidities included obesity (n = 32; 40%), diabetes mellitus (n = 12; 9%), and tobacco use (n = 67; 52%). Thirty (23%) were open injuries, and concomitant forefoot injuries were present in 47% and hindfoot injuries in 12%. Unplanned secondary procedures, including implant removals, were performed on 39 patients (33%), most often for removal of painful implants (26%) or infectious debridement (9%). Sixty-seven complications occurred, with PTA most frequent (37%). Deep infections occurred in 8%. On multivariate analysis, open injury ( P = 0.028, CI = 1.22-30.63, OR = 6.12) and concomitant forefoot injury ( P = 0.03, CI = 1.12-9.76, OR = 3.31) were independent risk factors for complication. CONCLUSIONS Open Lisfranc injuries were associated with complications, with deep infections occurring in 9%. Secondary procedures were most often performed for pain relief; the most common late complication was PTA, warranting counseling of patients about potential long-term sequelae of injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Alex Benedick
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Michael Kavanagh
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Nicholas Alfonso
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO
| | - Heather A Vallier
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH; and
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Walsh A, Kasture S, Sugathan H, Dalal R. Long term results and patient reported outcome measures following lisfranc injuries treated with memory staple fixation. Foot (Edinb) 2023; 56:101991. [PMID: 36924628 DOI: 10.1016/j.foot.2023.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Various modalities of fixation have been proposed for Lisfranc injuries. Memory staple fixation offers a simple option for transarticular fixation in suitable fracture configuration with no diaphyseal extension. However there is little evidence available in the literature regarding its efficacy and patient reported outcomes. Aim of the study was to present the long term outcomes of Lisfranc injuries treated with memory staple fixation and patient reported outcomes at average follow-up of four years. METHOD This was a retrospective analysis of all the patients who underwent fixation for Lisfranc injury using shape memory alloy (Nitinol) staples from December 2010 to October 2018. Patient demography, mechanism of injury, classification of Lisfranc injury, duration of followup, complication, revision surgery, implant removal and patient reported outcomes (AOFAS midfoot score) was noted. RESULTS 31 patients satisfied the inclusion criteria. Mean age was 50 years and 17 patients were females. 54 % patients reported low to moderate energy trauma which included simple fall from standing height or twisting injury. 28 (90.3 %) had B2 type of fracture pattern. 13 had fixation with staples only, 15 with a staple and home run screw. No patient had primary fusion. One patient had superficial infection treated with antibiotics only. Three patients developed symptomatic arthritis, out of which one proceeded to fusion. Six had implant removal for hardware related symptoms. Average AOFAS midfoot score at average four years follow-up was 77.8 which are satisfactory. CONCLUSION This paper highlights good outcome following memory staple fixation for Lisfranc injuries. We believe staples are more suited for the dorsal buttressing that is typically required and provide stable, reproducible fixation Our findings also suggest less need for implant removal compared to transarticular screw or plate fixation though larger studies would be required to make definitive conclusions.
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Affiliation(s)
- Anna Walsh
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK
| | - Sarang Kasture
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK.
| | - Hari Sugathan
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK
| | - Rakesh Dalal
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK
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Chen C, Jiang J, Wang C, Zou J, Shi Z, Yang Y. Is the diagnostic validity of conventional radiography for Lisfranc injury acceptable? J Foot Ankle Res 2023; 16:9. [PMID: 36855126 PMCID: PMC9976526 DOI: 10.1186/s13047-023-00608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Lisfranc injuries mainly involve the tarsometatarsal joint complex and are commonly misdiagnosed or missed in clinical settings. Most medical institutions prefer to use conventional radiography. However, existing studies on conventional radiographs in Lisfranc injury lack a large population-based sample, influencing the validity of the results. We aimed to determine the diagnostic validity and reliability of conventional radiography for Lisfranc injury and whether computed tomography can alter clinical decision-making. METHODS This retrospective study included 307 patients with, and 100 patients without, Lisfranc injury from January 2017 to December 2019. Diagnosis was confirmed using computed tomography. A senior and junior surgeon independently completed two assessments of the same set of anonymised conventional radiographs at least 3 months apart. The surgeons were then asked to suggest one of two treatment options (surgery or conservative treatment) for each case based on the radiographs and subsequently on the CT images. RESULTS All inter- and intra-observer reliabilities were moderate to very good (all κ coefficients > 0.4). The mean (range) true positive rate was 81.8% (73.9%-87.0%), true negative rate was 90.0% (85.0%-94.0%), false positive rate was 10.0% (6.0%-15.0%), false negative rate was 18.2% (13.0%-26.1%), positive predictive value was 96.1% (93.8%-97.8%), negative predictive value was 62.4% (51.5%-69.7%), classification accuracy was 83.8% (76.7%-88.2%), and balanced error rate was 14.1% (10.2%-20.5%). Three-column injuries were most likely to be recognized (mean rate, 92.1%), followed by intermediate-lateral-column injuries (mean rate, 81.5%). Medial-column injuries were relatively difficult to identify (mean rate, 60.7%). The diagnostic rate for non-displaced injuries (mean rate, 76.7%) was lower than that for displaced injuries (mean rate, 95.5%). The typical examples are given. A significant difference between the two surgeons was found in the recognition rate of non-displaced injuries (p = 0.005). The mean alteration rate was 21.9%; the senior surgeon tended to a lower rate (15.6%) than the junior one (28.3%) (p < 0.001). CONCLUSIONS The sensitivity, specificity, and classification accuracy of conventional radiographs for Lisfranc injury were 81.8%, 90.0%, and 83.8%, respectively. Three-column or displaced injuries were most likely to be recognized. The possibility of changing the initial treatment decision after subsequently evaluating computed tomography images was 21.9%. The diagnostic and clinical decision-making of surgeons with different experience levels demonstrated some degree of variability. Protected weight-bearing and a further CT scan should be considered if a Lisfranc injury is suspected and conventional radiography is negative.
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Affiliation(s)
- Cheng Chen
- grid.24516.340000000123704535Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092 China ,grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China
| | - JianTao Jiang
- grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China ,Department of Orthopedics, Shaoxing Shangyu Hospital of Chinese Medicine, Shaoxing, 312000 China
| | - Cheng Wang
- grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China
| | - Jian Zou
- grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China
| | - ZhongMin Shi
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233, China.
| | - YunFeng Yang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Antoniadou T, Dimopoulos L, Nikolaides AP, El Gamal T. Plantar Subluxation of First Metatarsal with Intercuneiform Dislocation: A Case Report of a New Type of Lisfranc Injury. J Long Term Eff Med Implants 2023; 33:89-94. [PMID: 36734931 DOI: 10.1615/jlongtermeffmedimplants.2022039173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lisfranc injuries result when the bones or ligaments that support the midfoot are torn, and the classifications of these injuries are based on the coronal displacement of the metatarsals. On the saggital plane, the first metatarsal is usually dorsally dislocated due to dorsal ligament weakness. We present a case report of a 29-year-old woman who sustained a Lisfranc injury of her right foot with plantar subluxation of the first metatarsal, which was treated with open reduction and internal fixation of the first metatarsal and fusion of the second metatarsal.
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Affiliation(s)
- Thekla Antoniadou
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Leonidas Dimopoulos
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, B15 2GW Birmingham UK
| | - A P Nikolaides
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, B15 2GW Birmingham UK; University of Birmingham, B15 2TH Birmingham, UK
| | - T El Gamal
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
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Zhao TH, Chen HX, Jia B, Bai YB, Lu J, Ren W. A modified three-incision approach to treating three-column Lisfranc injuries. Chin J Traumatol 2022; 25:362-366. [PMID: 35985903 PMCID: PMC9751575 DOI: 10.1016/j.cjtee.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/21/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach, which frequently causes a variety of complications, such as skin necrosis, rotational malreduction of the first tarsometatarsal joint (TMTJ) and lateral column dorsoplantar malreduction of the TMTJ. We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function. METHODS We prospectively selected 30 previously healthy patients, ranging from 18 to 60 years of age, but only 23 patients completed the follow-up and thus were finally included, with an average age of 38.1 ± 12.9 years. All patients have sustained Lisfranc fracture-dislocations involving all three-column; 13.0% (3/23) were Myerson classification type A (medial), 47.8% (11/23) were type A (lateral), and 39.1% (9/23) were type C2. All patients were treated via a three-incision approach: a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs, as well as to apply internal fixation instrumentation; a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision, ensuring good reduction of the first TMTJ in medial and plantar view; another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column. Mean ± SD was used for quantitative data such as operation time, follow-up time and foot function scores. Postoperative complications were documented, and foot function was evaluated using the American orthopaedic foot & ankle society score, foot function index and Maryland foot score at follow-up. The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up, and independent sample t-test was used for statistical analysis. RESULTS The median operation time was 117.9 ± 14.6 min (range 93 - 142 min). All complications occurred within three months after the operation, and included delayed wound healing (17.4%), superficial infection (8.7%), complex regional pain syndrome (4.3%) and neuroma (4.3%). There was no case of postoperative skin necrosis or malreduction. At the end of follow-up of 14.1 ± 1.2 months (range 12-16 months), the median American orthopaedic foot & ankle society score of the operated foot was 89.7 ± 5.7, the median foot function index was 21.7 ± 9.9, and the median Maryland foot score was 88.7 ± 4.8. There were no significant differences between the operated and contralateral sides, in terms of foot function, at the end of followup (p > 0.05). CONCLUSION The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation, which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.
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Affiliation(s)
- Ting-Hu Zhao
- Department of Foot and Ankle, Shen Zhen Ping Le Orthopaedic Hospital, Shenzhen, 518118, Guangdong Province, China
| | - Han-Xin Chen
- Department of Foot and Ankle, Shen Zhen Ping Le Orthopaedic Hospital, Shenzhen, 518118, Guangdong Province, China
| | - Bin Jia
- Department of Foot and Ankle, Shen Zhen Ping Le Orthopaedic Hospital, Shenzhen, 518118, Guangdong Province, China
| | - Yun-Bo Bai
- Department of Orthopaedic Trauma, Shen Zhen Ping Le Orthopaedic Hospital, Shenzhen, 518118, Guangdong Province, China
| | - Jike Lu
- Department of Orthopedic Surgery, United Family Hospital, Beijing, 100015, China
| | - Wei Ren
- Department of Orthopedic Surgery, United Family Hospital, Beijing, 100015, China,Corresponding author.
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Walley KC, Semaan DJ, Shah R, Robbins C, Walton DM, Holmes JR, Talusan PG. Long-term Follow-up of Lisfranc Injuries Treated With Open Reduction Internal Fixation Patient-Reported Outcomes. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211039496. [PMID: 35097469 PMCID: PMC8702685 DOI: 10.1177/24730114211039496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There remains a paucity of data regarding long-term patient-reported outcomes following Lisfranc injuries. We sought to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and visual analog scale–foot and ankle (VAS-FA). Methods: A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of the 45 patients identified, we were able to recruit 19 for a follow-up clinic visit consisting of physical examination, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and visual analog scale–foot and ankle. Results: There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4±8.2 and the mean VAS–foot and ankle score was 76.6±22.3. Conclusion: We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Derek J Semaan
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ronit Shah
- College of Medicine, University of Toledo, Toledo, OH, USA
| | - Christopher Robbins
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David M Walton
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - James R Holmes
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul G Talusan
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Philpott A, Epstein DJ, Lau SC, Mnatzaganian G, Pang J. Lisfranc Fixation Techniques and Postoperative Functional Outcomes: A Systematic Review. J Foot Ankle Surg 2021; 60:102-108. [PMID: 33039319 DOI: 10.1053/j.jfas.2020.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/10/2019] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
The optimal method of fixation of acute Lisfranc injuries is yet to be established. We aim to systematically review the literature to identify the impact of fixation method on postoperative functional outcomes. A systematic review was undertaken using the PRISMA framework to identify all studies reporting postoperative functional outcomes in patients who underwent open-reduction internal fixation of acute Lisfranc injuries. Studies reporting outcomes of numerous fixation methods were divided into fixation subcohorts. Studies comparing bridge plate with transarticular screw fixation were included for meta-analysis, conducted using a random-effects model. Seventeen studies (20 subcohorts) with 462 patients were included. Mean patient age was 29.6 (rang, 15-81) years. Mean follow-up was 38.7 (range 11 to 287) months. American Academy of Orthopaedic Surgeons midfoot score (AOFAS-MF) was the most frequently reported functional outcome (16/20 subcohorts). Overall weighted mean AOFAS-MF was 76.3 ± 9.4 for all cases, with 74.2 ± 9.4 for transarticular screws and 79.2 ± 8.3 for bridge plates. The mean difference between screw and plate was not statistically significant (mean difference = 5.0, 95% confidence interval, -4.8 - 14.8, p = .3). A single study reported AOFAS-MF mean of 92 using suture button fixation. Meta-analysis of the 2 available comparative studies revealed higher postoperative AOFAS-MF with bridge plate fixation (pooled standardized mean difference, 0.51; 95% confidence interval, 0.15-0.87, p = .006). There is scarcity of literature examining the impact of fixation method on postoperative functional outcomes in acute Lisfranc injuries. A small number of studies have reported superior functional outcomes with use of bridge plate fixation. Further evidence is needed to ascertain which injuries are best managed with each fixation method or whether 1 fixation construct is universally superior.
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Affiliation(s)
- Andrew Philpott
- Orthopaedic Registrar, Bendigo Base Hospital, Bendigo, Victoria, Australia.
| | - Daniel J Epstein
- Orthopaedic Registrar, Bendigo Base Hospital, Bendigo, Victoria, Australia
| | - Simon C Lau
- Orthopaedic Registrar, Royal Melbourne Hospital, Victoria, Australia
| | - George Mnatzaganian
- Statistician, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Jack Pang
- Consultant Orthopaedic Surgeon, Bendigo Base Hospital, Bendigo, Victoria, Australia
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Sports-Related Lisfranc Injuries and Recognition of Lisfranc Variants: Surgical Strategies for Stabilization. Foot Ankle Clin 2021; 26:13-33. [PMID: 33487236 DOI: 10.1016/j.fcl.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Much has changed since Lisfranc described lesions at the tarsometatarsal (TMT) joint in 1815. What was considered an osseous high-energy condition nowadays is understood as myriad possible presentations, occurring in minor and inconspicuous traumas. Advancements in diagnostics of Lisfranc injury allow recognizing many variants of this trauma presentation, most of them with a focus on ligaments. This perception shifted trends in surgical planning, especially for implants and fixation techniques. These revolutions established a new and evolving universe around TMT lesions, different from what was known only a few years ago and still not enough to completely settle the disease scenario.
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Abstract
The reported incidence of Lisfranc injuries is 9.2/100.000 person-years; two-thirds of the injuries are nondisplaced. Tarsometatarsal injuries range from minor sprains and isolated ligamentous injuries to grossly unstable and multiligamentous lesions. High-energy injuries are usually linked with mechanical energy dissipation through the soft tissues. Operative treatment options include open reduction and internal fixation, open reduction with hybrid internal and external fixation, closed reduction with percutaneous internal or external fixation, and primary arthrodesis. Treatment goals are to obtain a painless, plantigrade, and stable foot. Anatomic reduction is a key factor for improved outcomes and decreased rates of post-traumatic arthritis.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 333, Cerqueira Cesar, Sao Paulo, São Paulo 05403-010, Brazil; Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins drive, Iowa City, IA 52242, USA
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Li X, Jia LS, Li A, Xie X, Cui J, Li GL. Clinical study on the surgical treatment of atypical Lisfranc joint complex injury. World J Clin Cases 2020; 8:4388-4399. [PMID: 33083398 PMCID: PMC7559651 DOI: 10.12998/wjcc.v8.i19.4388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/20/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past, and there is little related research on the diagnosis and treatment of these injuries. In recent years with the rise in foot and ankle surgery, doctors are now paying more attention to this type of injury. However, there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments, which eventually result in greater sequelae; including long-term pain, arthritis, foot deformity etc. In particular, for cases with a mild Lisfranc joint complex injury, the incidence of sequelae is higher.
AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.
METHODS The clinical data of 18 patients, including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed. All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires. X-ray images were taken and follow-up was performed monthly after the operation; the internal fixation was then removed 4-5 mo after the operation; and the American Orthopedic Foot and Ankle Society (AOFAS) score was used for evaluation on the last follow-up.
RESULTS All patients were followed up for 6-12 mo. A good/excellent AOFAS score was observed in 88.9% of patients.
CONCLUSION For atypical Lisfranc joint complex injuries, active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.
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Affiliation(s)
- Xu Li
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Le-Sheng Jia
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Ang Li
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Xin Xie
- Department of Functional Experiment Center, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
| | - Jun Cui
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Guo-Liang Li
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
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Abstract
PURPOSE OF REVIEW To outline the classic and recent literature of midfoot fractures and dislocations. RECENT FINDINGS There has been an evolution of implant technology to include mini-fragment fixation, suture fixation, and staples. Their efficacy is still being elucidated in the literature. Also, there has been a recent push for primary fusion, which we will discuss. Open reduction internal fixation of the midfoot remains to be the gold standard treatment, to which all other treatments are compared. It remains to be seen if adjunct fixation techniques are efficacious enough to provide a good result. Further study is needed to determine which patients are likely to progress to debilitating arthrosis and require fusion.
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Affiliation(s)
- Atif Ahmed
- Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Edward Westrick
- Allegheny General Hospital, 1307 Federal Street, Pittsburgh, PA, 15212, USA
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13
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Philpott A, Lawford C, Lau SC, Chambers S, Bozin M, Oppy A. Modified Dorsal Approach in the Management of Lisfranc Injuries. Foot Ankle Int 2018; 39:573-584. [PMID: 29320935 DOI: 10.1177/1071100717750837] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open reduction and internal fixation of Lisfranc injuries has typically used multiple longitudinal incisions or a single transverse incision to approach the tarso-metatarsal joint (TMTJ). The incidence of wound-related complications is considerable. We describe a novel single-incision approach that utilizes subcutaneous windows to the medial TMTJ. METHODS A retrospective review identified 150 patients who underwent open reduction and internal fixation for Lisfranc injuries, via the modified dorsal approach, at our center between January 2011 and June 2016. Removal of hardware (ROH) was routinely undertaken in 105 patients at a median of 210 days postoperatively. Medical records were reviewed to record patient demographics, mechanism of injury, and operative details. Outpatient notes were reviewed to identify wound-related complications, including delayed wound healing, superficial infection, wound dehiscence, deep infection, complex regional pain syndrome (CRPS), neuroma, and impaired sensation. Median age was 37 years (range, 19-78 years). Seventy-three percent of patients (110) were male. Most frequent mechanisms of injury were motor vehicle accident (MVA), 39%; motorbike accident (MBA), 19%; and fall, 18%. Sixteen percent (24) of injuries were open. Five patients required soft tissue reconstruction at the primary operation. Median follow-up was 144 (range, 27-306) weeks. RESULTS Following the primary procedure, 14% of patients experienced wound-related complications including delayed healing (3%), superficial infection (5%), dehiscence (3%), complex regional pain syndrome (CRPS) (1%), and impaired sensation (1%). MBA injuries were at 15.1 times odds of superficial infection ( P =.01) than were MVA injuries. Following ROH, 13% of patients experienced wound-related complications, including delayed healing (2%), superficial infection (8%), dehiscence (1%), CRPS (2%), and neuroma (1%). Overall, 5 patients returned to surgery for soft tissue reconstruction for wound dehiscence. CONCLUSION The modified dorsal approach using intervals to the midfoot offers a viable alternative with comparable wound complication rates to existing midfoot approaches. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | | | - Simon C Lau
- 1 Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Andrew Oppy
- 1 Royal Melbourne Hospital, Melbourne, Australia
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